Xantoma del tendón de aquiles bilateral: debut de xantomatosis cerebrotendinosa / Bilateral achilles tendon xanthoma: cerebrotendinous xanthomatosis debut

OBJETIVO Presentación de un inusual caso de xantomatosis cerebrotendinosa en un paciente de edad cuya primera manifestación fueron xantomas bilaterales del tendón de Aquiles. MATERIAL Y MÉTODOS Mujer de 62 años, que presenta tumoraciones, que presenta tumoraciones sólidas y polilobuladas, en la cara posterior de ambos tendones de Aquiles de 8 años de evolución. El diagnóstico se realizó mediante el hallazgo de hiperlipidemia y estudio genético. Se realió la exóresis quirúrgica parcial de las tumoraciones. RESULTADOS A los 5 años de la cirugía del pie izquierdo y 4 años del pie derecho la paciente estaba asintomática. Presentaba una fuerza para la flexión plantar bilateral de 5/5, pudiendo caminar y subir escaleras sin molestias. Presentaba una escala AOFAS de 85 y 90 puntos en el pie izquierdo y derecho, respectivamente. No hubo recidivas. DISCUSIÓN Los xantomas son depósitos de colesterol en el tejido conectivo de la piel, tendones o fascia, como resultado de una hiperlipoproteinemia. La importancia del caso radica en su sospecha diagnóstica, ya que la xantomatosis cerebrotendinosa suele manifestarse en pacientes de menos de 30 años de edad y en los que se ha recomendado la resección radical de las tumoraciones, e incluso del tendón, debido a las frecuentes recidivas. CONCLUSIÓN En pacientes de mayor edad con lesiones que infiltran el tendón, se puede optar por un tratamiento menos agresivo con un buen resultado clínico.

OBJETIVE Presentation of an unusual case of cerebrotendinous xanthomatosis in an elderly patient whose first manifestation was bilateral Achilles tendon xanthomas. MATERIAL AND METHODS 62-year-old woman presenting solid and polylobed tumors on the posterior aspect of both Achilles tendons for eight years. The diagnosis was made by means of hyperlipidemia and a genetic study. Surgical partial excision of the tumors was performed. RESULTS Five years after surgery on the left foot and four years after the right foot, the patient was asymptomatic. Bilateral plantar flexion force was 5/5, The patient was able to walk and climb stairs without discomfort. AOFAS score was 85 and 90 on the left and right feet, respectively. There were no recurrences. DISCUSSION Xanthomatosis is a genetic alteration with deposits of cholesterol in connective tissue of the skin, tendons or fascia, because of hyperlipoproteinemia. The importance of the present case lies in its diagnostic suspicion, since cerebrotendinous xanthomatosis manifests usually in patients under 30 years of age and in whom radical resection of tumors, and even of the tendon, has been recommended due to frequent recurrences . CONCLUSION In older patients with tumors that infiltrate the tendon, a less aggressive treatment can be chosen with a good clinical result.

Differential diagnosis and treatment options for xanthogranulomatous cholecystitis

To describe the differential diagnosis and treatment options for xanthogranulomatous cholecystitis [XGC], the presentations and management of 68 patients were described. Demographical and clinical data from 68 cases of XGC treated between January 2004 and January 2010 were analyzed. Clinical characteristics, radiological and surgical findings, histopathological features and postoperative recoveries were recorded. Clinical features of laparoscopic cholecystectomy versus open surgery and XGC versus gallbladder [GB] cancer were compared. The CA19-9 levels of XGC and coexisting GB cancer were significantly different [p = 0.0034]. In radiological findings, focal thickening of the GB wall was more frequent in coexisting GB cancer, early enhancement of the GB was observed more often in coexisting GB cancer, and lymph node enlargement was seen more often in coexisting GB cancer [p < 0.05]. There were also significant differences between laparoscopic and open surgery for CA19-9, intramural hypoattenuated nodule, pericholecystic invasion, lymph node enlargement and maximum thickness, focal thickening, heterogeneous enhancement and early enhancement of the GB wall [p < 0.05]. These findings were confirmed by multivariate analysis. Ultrasound, computed tomography scan and intraoperative frozen section were the helpful modalities for XGC diagnosis. CA19-9 [>37 kU/l], pericholecystic invasion, lymph node enlargement [>10 mm], and focal thickening and early enhancement of the GB wall were the criteria for open surgery. In some selected cases, laparoscopic cholecystectomy was preferable

Blefaroplastia associada a enxertia de pele autóloga para xantelasmas extensos: relato de caso / Extensive xanthelasma: a surgical solution: case report

O xantelasma pode ser tratado por uso de ácidos, laser ou cirurgia com fechamento primário, todos apresentando recidivas freqüentes, além de ineficazes em casos extensos. Os autores apresentam a reabilitação funcional e estética em uma paciente com recidiva de xantelasmas extensos nas porções mediais das quatro pálpebras em que foi realizada exérese das lesões associadas à blefaroplastia superior e inferior, com utilização da pele retirada para enxerto em transferência mútua, ou seja, o excesso de pele de pálpebras superiores utilizado para enxertia em pálpebras inferiores e vice-versa.

Xanthelasma can be treated with acids, laser or primary suture, all presenting frequent relapses besides being inefficacious in extensive cases. The authors present the functional and esthetic result of a female patient's case with extensive xanthelasmas on the upper and lower eyelids which were removed combined with upper and lower blepharoplasty, using the skin removed from the upper eyelids to cover the defect in the lower, and vice-versa.

Xanthogranulomatous cystitis: case report and literature review

A cistite xantogranulomatosa (CX) é uma rara doença inflamatória crônica e benigna de etiologia desconhecida. É apresentado um caso de cistite xantogranulomatosa em um paciente masculino de 53 anos. A evolução do paciente incluiu estudos clínicos, radiológicos e histológicos. Não houve recorrência em 32 meses de seguimento após o tratamento. Este caso é provavelmente o 21o a ser relatado no mundo, e o primeiro caso na literaturabrasileira

Xanthogranulomatous cystitis (XC) is a rare benign chronic inflammatory disease of unknown etiology. A case of Xanthogranulomatous cystitis in a 53 year-old male is presented. Patient evolution included clinical, radiological, and histological studies. He had no recurrence of XC 32 months after treatment. The present case is probably the 21st to be reported in the world, and the first case in the Brazilian literature

Colecistitis xantogranulomatosa / Xanthogranulomatous cholecystitis

Se presenta un reporte de cuatro casos de colecistitis xantogranulomatosa, de un total de 1920 biopsias de pacientes colecistectomizados en el servicio de cirugía del Hospital de Quilpué, entre los años 1993 y 2002. Esto constituye un 0,2 por ciento del total de vesículas extirpadas. Tres casos corresponden al sexo masculino, uno al femenino; con una edad promedio de 62 años. El diagnóstico preoperatorio fue de ictericia obstructiva en tres casos y en dos de ellos, el diagnóstico macroscópico intraoperatorio fue de cáncer vesicular. El estudio histopatológico demostró una colecistitis xantogranulomatosa, sin evidencia de malignidad.

Quimioesfoliaçäo do xantelasma palpebral com ácido tricloroacético / Chemexfoliation of eyelid xanthelasma with trichoroacetic acid

Os autores estudam a quimioesfoliaçäo do Xantelasma palpebral com soluçäo saturada de ATA em 250 pacientes com idade variando de 35 a 67 anos, num período de 20 anos. Mostram que é um método seguro, de fácil aplicaçäo e eficaz no tratamento desta afecçäo. Revisam a açäo terapêutica do ATA em outras condiçöes como cicatrizes de acne, hipercromias localizadas, rugas, sardas e molusco contagioso em pacientes imunocomprometidos com o vírus HIV. Discutem outra modalidades de tratamento com a exérese cirúrgica associada ou näo a blefaroplastia, e a exertia de pele.